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� �CT�ECK Ok'F i.IST FOR xSSUANCE OF�'E�'VIITS <br /> ` FOR OFFICE USE ONLY� � . <br /> A.pDRE�S ORLEGAL: ,AI(1�� ��� . <br /> PID: <br /> 77ESCRIl'`I'SO�T OF'WORK: i�. <br /> _-----��V BY: ^-------____�--------------pATE---------------- ..�- Qe. � l�( <br /> Z4YING �2E . . DATE APPROVED, <br /> �UII�DING REVIEtiY BY: -�-----------------------=--------------------------------- <br /> �'EES TO BE CHARGE]J:^ ^ � Misc. Fees Calculated By: <br /> P���T Yes No <br /> PLAN REVTEtiY �� Yes No SE�YER C�NNECI'ION <br /> tiVA'I�RCONNECTION <br /> STATE SURCHARGE YeS No p�g�{ gEE <br /> INVESTIGATION FEE Ye5 No STT'EINSPEC'�'ION <br /> SAC Yes � <br /> ber of SAC�Units OTHER (specify) . <br /> --Num ------------------------------—----------------------------------------------------------------------- � <br /> Zp�IG C�CK LIST Zoaing District: — _ • <br /> ; <br /> � Post Office: School District: • � <br /> Fire DeparcmeQr. � <br /> L,ot Area: Sq.ft. _ Acres � Widch Depth i <br /> j.(o Date of 5urvey: Z+00`� " ��^�(R^ �r�n <br /> Survey Submicted:� Z'es_l� �vt bY �'I��J <br /> Proposed Setbacks': gl��Side: ' � s�� �'�i°�'� <br /> Froa[(Lake): s c�c,e s �0 32� ' <br /> Rear(Street): _ Left Side: 3S' reQ��c� <br /> A3;acent Stn�ch�res: `Vetl�nd: <br /> Building Hei�t: DeE. Hgt. peal`H°�' <br /> Lot Covera?e: � P'� �� L �' <br /> g Council Approval Date: <br /> Grading: Scaff Approval Date: Y� <br /> Szptic: Staff Approvai Date: �ti �Y� �-`� <br /> Zp�� F�e: �__ Resolutioo: n______ Resolution Date: <br /> Shorzland District: �;Cove2�e: <br /> Av�. Setbacb_: E!uF�SetSack: <br /> E�stiag Proposed <br /> Ha�ecovec: G-7�' - <br /> 75-250' - <br /> 250-S��J' -- ha�rizcve.r es�lGS <br /> � 5u0-iCC�' dc.v.rt_ b� b��lci,n.r l <br /> no r,2� c��ta� <br /> ,' ' /��...- A�.�.�j•'��: <br /> , ' _Jc; .�.._. <br /> �??�CCO`;eC ti Z:"�^.C2 Ft?=il:'.i2�: ,2> >,n ... O: �..v:_-.- — <br /> F.ElL'�R.�S �.L�ho��e): <br />